{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T01:09:53Z","timestamp":1784768993256,"version":"3.55.0"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,9,1]],"date-time":"2022-09-01T00:00:00Z","timestamp":1661990400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,9,1]],"date-time":"2022-09-01T00:00:00Z","timestamp":1661990400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002957","name":"Technische Universit\u00e4t Dresden","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002957","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Health Serv Res"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Rising surgery rates have raised questions about the indications for spinal surgery. The study investigated patient-level and regional factors associated with spinal surgery for patients with spinal diseases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We undertook a cohort study based on routine healthcare data from Germany of 18.4 million patients within 60.9 million episodes of two patient-years before a possible spinal surgery in the time period 2008 to 2016. Using a Poisson model, the effects of a broad range of patient-related (sociodemographic, morbidity, social status), disease- and healthcare-related (physicians\u2019 specialty, conservative treatments) and regional variables were analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There was substantial regional heterogeneity in the occurrence of spinal surgery which decreased by only one quarter when controlling for the various determinants assessed. Previous musculoskeletal and mental health disorders as well as physical therapy were associated with a lower probability of surgery in the fully-adjusted model. Prescriptions for pain medication and consultations of specialists were associated with a higher probability of surgery. However, the specific severity of the vertebral diseases could not be taken into account in the analysis. Furthermore, a substantial proportion of patients with surgery did not receive a consultation with an outpatient specialist (29.5%), preoperative diagnostics (37.0%) or physical therapy (48.3%) before hospital admission.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This large study on spinal diseases in Germany highlights important patterns in medical care of spinal diseases and their association with the probability of spinal surgery. However, only a relatively small proportion of the regional heterogeneity in spinal surgery could be explained by the extensive consideration of confounders, which suggests the relevance of other unmeasured factors like physicians\u2019 preferences.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s12913-022-08492-3","type":"journal-article","created":{"date-parts":[[2022,9,1]],"date-time":"2022-09-01T17:03:57Z","timestamp":1662051837000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Indication for spinal surgery: associated factors and regional differences in Germany"],"prefix":"10.1186","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8933-643X","authenticated-orcid":false,"given":"Falko","family":"Tesch","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8671-7496","authenticated-orcid":false,"given":"Toni","family":"Lange","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrik","family":"Dr\u00f6ge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"G\u00fcnster","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Flechtenmacher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burkhard","family":"Lembeck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernd","family":"Kladny","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dieter Christian","family":"Wirtz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fritz-Uwe","family":"Niethard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0264-0960","authenticated-orcid":false,"given":"Jochen","family":"Schmitt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,9,1]]},"reference":[{"key":"8492_CR1","volume-title":"Global Health Estimates 2016: disease burden by cause, age, sex, by country and by region 2000\u20132016","author":"WHO","year":"2018","unstructured":"WHO. Global Health Estimates 2016: disease burden by cause, age, sex, by country and by region 2000\u20132016. 2018."},{"issue":"27\u201328","key":"8492_CR2","first-page":"1362","volume":"110","author":"F Niethard","year":"2013","unstructured":"Niethard F, Malzahn J, Sch\u00e4fer T. Endoprothetik und Wirbels\u00e4uleneingriffe: Uneinheitliches Versorgungsgeschehen. Dtsch Arztebl International. 2013;110(27\u201328):1362\u20135.","journal-title":"Dtsch Arztebl International"},{"issue":"23","key":"8492_CR3","doi-asserted-by":"publisher","first-page":"2707","DOI":"10.1097\/01.brs.0000248132.15231.fe","volume":"31","author":"JN Weinstein","year":"2006","unstructured":"Weinstein JN, Lurie JD, Olson PR, Bronner KK, Fisher ES. United States\u2019 trends and regional variations in lumbar spine surgery: 1992\u20132003. Spine (Phila Pa 1976). 2006;31(23):2707\u201314.","journal-title":"Spine (Phila Pa 1976)"},{"issue":"8","key":"8492_CR4","doi-asserted-by":"publisher","first-page":"e028743","DOI":"10.1136\/bmjopen-2018-028743","volume":"9","author":"M Grotle","year":"2019","unstructured":"Grotle M, Sm\u00e5stuen MC, Fjeld O, Gr\u00f8vle L, Helgeland J, Storheim K, Solberg TK, Zwart J-A. Lumbar spine surgery across 15 years: trends, complications and reoperations in a longitudinal observational study from Norway. BMJ Open. 2019;9(8):e028743.","journal-title":"BMJ Open"},{"key":"8492_CR5","volume-title":"The Dartmouth Atlas of Musculoskeletal Health Care","author":"JN Weinstein","year":"2000","unstructured":"Weinstein JN, Birkmeyer JD, Abdu WA, Birkmeyer NO\u2019C, Bronner KK, Cooper MM, Lurie JD, Sharp SM, Shawver TA, Siewers AE. The Dartmouth Atlas of Musculoskeletal Health Care. Chicago, Illinois: American Hospital Association; 2000."},{"issue":"03","key":"8492_CR6","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1055\/s-0043-124768","volume":"156","author":"T Petzold","year":"2018","unstructured":"Petzold T, Tesch F, Adler J, G\u00fcnster C, Niethard F, Schmitt J. 10-Jahres-Entwicklung operativer Eingriffe an der Wirbels\u00e4ule in Deutschland. Z Orthop Unfall. 2018;156(03):298\u2013305.","journal-title":"Z Orthop Unfall"},{"key":"8492_CR7","doi-asserted-by":"publisher","unstructured":"M\u00e4ntym\u00e4ki H, Ponkilainen VT, Huttunen TT, Mattila VM. Regional variations in lumbar spine surgery in Finland. Arch Orthop Trauma Surg.\u00a02021. https:\/\/doi.org\/10.1007\/s00402-021-04313-0.","DOI":"10.1007\/s00402-021-04313-0"},{"issue":"6","key":"8492_CR8","doi-asserted-by":"publisher","first-page":"E372","DOI":"10.1097\/BRS.0000000000002858","volume":"44","author":"L Gr\u00f8vle","year":"2019","unstructured":"Gr\u00f8vle L, Fjeld OR, Haugen AJ, Helgeland J, Sm\u00e5stuen MC, Solberg TK, Zwart JA, Grotle M. The Rates of LSS Surgery in Norwegian Public Hospitals: A Threefold Increase From 1999 to 2013. Spine. 2019;44(6):E372\u20138.","journal-title":"Spine"},{"issue":"5","key":"8492_CR9","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1007\/s00586-003-0544-9","volume":"12","author":"K\u00c5 Jansson","year":"2003","unstructured":"Jansson K\u00c5, Blomqvist P, Granath F, N\u00e9meth G. Spinal stenosis surgery in Sweden 1987\u20131999. Eur Spine J. 2003;12(5):535\u201341.","journal-title":"Eur Spine J"},{"issue":"2","key":"8492_CR10","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1016\/j.joca.2012.11.006","volume":"21","author":"T Sch\u00e4fer","year":"2013","unstructured":"Sch\u00e4fer T, Pritzkuleit R, Jeszenszky C, Malzahn J, Maier W, G\u00fcnther KP, Niethard F. Trends and geographical variation of primary hip and knee joint replacement in Germany. Osteoarthritis Cartilage. 2013;21(2):279\u201388.","journal-title":"Osteoarthritis Cartilage"},{"issue":"4","key":"8492_CR11","doi-asserted-by":"publisher","first-page":"1090","DOI":"10.1007\/s11999-011-2004-x","volume":"470","author":"SS Bederman","year":"2012","unstructured":"Bederman SS, Rosen CD, Bhatia NN, Kiester PD, Gupta R. Drivers of surgery for the degenerative hip, knee, and spine: a systematic review. Clin Orthop Relat Res. 2012;470(4):1090\u2013105.","journal-title":"Clin Orthop Relat Res"},{"issue":"02","key":"8492_CR12","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1055\/s-0034-1396815","volume":"77","author":"E Swart","year":"2015","unstructured":"Swart E, Gothe H, Geyer S, Jaunzeme J, Maier B, Grobe TG, Ihle P. Gute Praxis Sekund\u00e4rdatenanalyse (GPS): Leitlinien und Empfehlungen. Gesundheitswesen. 2015;77(02):120\u20136.","journal-title":"Gesundheitswesen"},{"key":"8492_CR13","unstructured":"European Union. Revision of the European Standard Population - Report of Eurostat's task force - 2013 edition. In. Edited by Eurostat. Luxembourg: Publications Office of the European Union; 2013."},{"issue":"2","key":"8492_CR14","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1111\/j.2517-6161.1948.tb00012.x","volume":"10","author":"PAP Moran","year":"1948","unstructured":"Moran PAP. The Interpretation of Statistical Maps. J R Stat Soc B. 1948;10(2):243\u201351.","journal-title":"J R Stat Soc B"},{"key":"8492_CR15","unstructured":"R Core Team. A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2019."},{"issue":"12","key":"8492_CR16","doi-asserted-by":"publisher","first-page":"1018","DOI":"10.1007\/s00132-018-3629-1","volume":"47","author":"T Lange","year":"2018","unstructured":"Lange T, Luque Ramos A, Albrecht K, G\u00fcnther K-P, Jacobs H, Schmitt J, Hoffmann F, Goronzy J, Postler A. Verordnungsh\u00e4ufigkeit physikalischer Therapien und Analgetika vor dem Einsatz einer H\u00fcft- bzw. Kniegelenks-Endoprothese. Der Orthop\u00e4de. 2018;47(12):1018\u201326.","journal-title":"Der Orthop\u00e4de"},{"issue":"6","key":"8492_CR17","doi-asserted-by":"publisher","first-page":"672","DOI":"10.1055\/a-0648-4945","volume":"156","author":"H Endres","year":"2018","unstructured":"Endres H, Schneider O, Scharf HP, Kaufmann-Kolle P, Knapstein S, Hermann C, Lembeck B, Flechtenmacher J. [Hip Osteoarthritis - Epidemiology and Current Medical Care Situation - Health Care Data of 2.4 Million AOK Baden-W\u00fcrttemberg Insurees Aged 40 Years or Older]. Z Orthop Unfall. 2018;156(6):672\u201384.","journal-title":"Z Orthop Unfall"},{"issue":"11","key":"8492_CR18","doi-asserted-by":"publisher","first-page":"953","DOI":"10.1097\/BRS.0b013e3182814ed5","volume":"38","author":"BJ Keeney","year":"2013","unstructured":"Keeney BJ, Fulton-Kehoe D, Turner JA, Wickizer TM, Chan KC, Franklin GM. Early predictors of lumbar spine surgery after occupational back injury: results from a prospective study of workers in Washington State. Spine (Phila Pa 1976). 2013;38(11):953\u201364.","journal-title":"Spine (Phila Pa 1976)"},{"issue":"5","key":"8492_CR19","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1056\/NEJM200102013440508","volume":"344","author":"RA Deyo","year":"2001","unstructured":"Deyo RA, Weinstein JN. Low back pain. N Engl J Med. 2001;344(5):363\u201370.","journal-title":"N Engl J Med"},{"issue":"3","key":"8492_CR20","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1007\/s00393-016-0178-z","volume":"76","author":"A Luque Ramos","year":"2017","unstructured":"Luque Ramos A, Hoffmann F. Kassenunterschiede bei chronischen R\u00fcckenschmerzen und Gelenkerkrankungen. Z Rheumatol. 2017;76(3):238\u201344.","journal-title":"Z Rheumatol"},{"issue":"3","key":"8492_CR21","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1093\/aje\/kwm070","volume":"166","author":"MA Brookhart","year":"2007","unstructured":"Brookhart MA, Patrick AR, Dormuth C, Avorn J, Shrank W, Cadarette SM, Solomon DH. Adherence to lipid-lowering therapy and the use of preventive health services: an investigation of the healthy user effect. Am J Epidemiol. 2007;166(3):348\u201354.","journal-title":"Am J Epidemiol"}],"container-title":["BMC Health Services Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-022-08492-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12913-022-08492-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-022-08492-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,3]],"date-time":"2024-10-03T02:50:02Z","timestamp":1727923802000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmchealthservres.biomedcentral.com\/articles\/10.1186\/s12913-022-08492-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,1]]},"references-count":21,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["8492"],"URL":"https:\/\/doi.org\/10.1186\/s12913-022-08492-3","relation":{},"ISSN":["1472-6963"],"issn-type":[{"value":"1472-6963","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,1]]},"assertion":[{"value":"27 February 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 August 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 September 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The ethics committee of the TU Dresden approved the study. Due to the use of secondary, routine care data, patient consent to participate was not required as confirmed by the ethics committee of the TU Dresden (reference number: EK 121042018). The study adheres to the guideline \"Good practice secondary data analysis\" (GPS) of the German Society for Epidemiology (Deutsche Gesellschaft f\u00fcr Epidemiologie, DGEpi) [].","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests regarding the submitted manuscript.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1109"}}